Drug interactions
Hydromorphone + Midazolam
Severity: Major
Hydromorphone and Midazolam: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Concomitant opioids and benzodiazepines can cause profound sedation, respiratory depression, coma and death. Regulators have issued boxed warnings for this class combination. Risk is greatest with parenteral midazolam, higher doses and in the elderly or those with respiratory disease.
What this interaction means in plain words
Hydromorphone and Midazolam can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Hydromorphone belongs to Musculoskeletal; Midazolam belongs to Central Nervous System.
Why it happens
Additive CNS and respiratory depression via opioid receptor and GABA-A receptor activity.
What to do
Reserve the combination for situations without alternatives, using the lowest doses and shortest duration. Provide continuous monitoring of respiratory rate and oxygen saturation, with resuscitation equipment available during procedural use.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Other interactions of Midazolam
- Atazanavir + Midazolam Contraindicated
- Cobicistat + Midazolam Contraindicated
- Darunavir + Midazolam Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Midazolam Contraindicated
- Fosamprenavir + Midazolam Contraindicated
- Indinavir + Midazolam Contraindicated
Frequently asked questions
Can I take Hydromorphone with Midazolam?
MediHelp rates the interaction as major. Hydromorphone and Midazolam can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Concomitant opioids and benzodiazepines can cause profound sedation, respiratory depression, coma and death. Regulators have issued boxed warnings for this class combination. Risk is greatest with parenteral midazolam, higher doses and in the elderly or those with respiratory disease.
How serious is the interaction between Hydromorphone and Midazolam?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reserve the combination for situations without alternatives, using the lowest doses and shortest duration. Provide continuous monitoring of respiratory rate and oxygen saturation, with resuscitation equipment available during procedural use.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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